Suitability for Selective Dorsal Rhizotomy (SDR)

Children between 3 and 10 years of age, with a diagnosis of
spastic diplegia, following premature birth, should be considered
for Selective Dorsal Rhizotomy. Older children are also considered
on a case by case basis.

Children with typical spastic diplegia, whether born prematurely
or at term, should also be considered. There should be no
significant damage to the areas of the brain involved in posture or
coordination; this would be determined by a magnetic resonance scan
of the brain.

Children suitable for SDR need to demonstrate adequate muscle
strength in the legs and trunk. Their ability to support their full
weight on their feet, to hold their posture against gravity, and to
make appropriate movements to crawl or walk is evaluated. These
children tend to have delayed motor development, and spasticity
interferes with their progress.

Regular post-operative physiotherapy is necessary to obtain the
best results after
SDR and suitable
children need to be motivated and show that they are able to
cooperate with therapy. Although it is ideal that children undergo
SDR prior to orthopaedic surgery, if the latter has already been
performed, it is recommended to delay SDR by at least six months to
allow muscle strength to recover.

Some causes of cerebral palsy are not suitable for SDR. Children
who have a history of meningitis, congenital infection,
hydrocephalus unrelated to prematurity or head trauma do not do
well with SDR.
Similarly, children with severe muscle rigidity, poor muscle tone
or dystonia do not benefit from SDR. SDR is also not very effective
for children with severe cerebral palsy involving the whole body or
when one side of the body is very weak. In children with severe
scoliosis,
SDR is not
generally recommended as it may cause the existing spinal curvature
to deteriorate.

How to find out if SDR is the best option for your
child

The first step is to obtain a referral for your child from your
GP, paediatrician, orthopaedic surgeon or neurologist. On
receiving this, we will first organise an appointment to see you
with your child at the neurosurgical spasticity clinic with a
consultant neurosurgeon and specialist physiotherapist. At this
clinic, the benefits and potential risks of SDR are discussed. We would
also aim to have a full and frank discussion about your
expectations, the consideration of other options and the need for
post-operative physiotherapy.

Following that appointment, your child may well be referred on
for a formal physiotherapy evaluation. Part of the evaluation is
video recorded. You will also be invited to attend the nearby
3D Gait Lab, and we will arrange for these appointments to
take place on the same day. This information then forms the
basis of a further multidisciplinary team (MDT) discussion,
attended by a paediatric neurosurgeon, paediatric orthopaedic
surgeon, paediatric neurologist and specialist physiotherapists. At
this stage, the brain scans, as well as the spine and hip x-rays,
are reviewed. The aim of this meeting is to decide whether a child
is suitable for SDR or whether other options may be potentially
better. The neurosurgeon on the panel will be in touch following
the MDT to discuss the outcome of the meeting and the
recommendations the group have made.